It is extremely rare for plastic surgery procedures where either skin grafts or skin and muscle grafts have been placed to be unsuccessful. However there are some instances when this mght occur.
For instance, if a person is having surgery on part of their body previously exposed to radiotherapy, the blood supply within the flap or on the area where it is being placed, might have been affected by the radiotherapy. The flap might not be receiving enough oxygen to survive and may become dusky before eventually becoming necrotic (dying) and failing.
Hyperbaric oxygen (HBO) is most useful early when a problem with flap viability has been identified and where the problem does not need further surgery to address it properly. HBO can provide higher levels of oxygen to a flap, helping meet the energy needs of the tissue.
HBO is not effective when a flap or graft has died (necrosis) so prompt referral is needed when a problem is suspected.
Hyperbaric oxygen is only indicated according to the UHMS in skin grafts or flaps which are showing signs of compromise. This may be due to radiation damage, areas of decreased perfusion or hypoxia. It is not a necessary adjunct in routine cases or for normally healing tissue.
Increasing oxygen tension in the tissue at risk leads to
- Reduction in hypoxic insult to tissue through reactive oxygen species
- Reduction in oedema by restoring cell membrane active transport
- Closure of AV shunts around areas of poor perfusion
- Improved microcirculation within capillaries
- Enhanced fibroblast function and collagen synthesis
- Neovascularisation
It must be borne in mind that HBO is best used as an adjunct to best standard clinical care.
Treatment entails up to 40 sessions of HBO over an 8 week period subject to response to treatment. If surgery is planned then this may be split into pre and post operative treatment.
Information on Referral & Funding can be found here.
References
Quirinia A, Viidik A. The impact of ischemia on wound healing is increased in old age but can be countered by hyperbaric oxygen therapy. Mech Ageing Dev. 1996 Oct 25;91(2):131-44. doi: 10.1016/0047-6374(96)01782-4. PMID: 8905610.
Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017 Mar;47(1):24-32. doi: 10.28920/dhm47.1.24-32. Erratum in: Diving Hyperb Med. 2017 Jun;47(2):131-132. doi: 10.28920/dhm47.2.131-132. PMID: 28357821; PMCID: PMC6147240.
Perrins DJ. Influence of hyperbaric oxygen on the survival of split skin grafts. Lancet. 1967 Apr 22;1(7495):868-71. doi: 10.1016/s0140-6736(67)91428-6. PMID: 4164367.
Roje Z, Roje Z, Eterović D, Druzijanić N, Petrićević A, Roje T, Capkun V. Influence of adjuvant hyperbaric oxygen therapy on short-term complications during surgical reconstruction of upper and lower extremity war injuries: retrospective cohort study. Croat Med J. 2008 Apr;49(2):224-32. doi: 10.3325/cmj.2008.2.224. PMID: 18461678; PMCID: PMC2359875.